An overview of the progress in the treatment of multiple myeloma.

Effective therapy for multiple myeloma has existed for a little more than the last half century. The introduction of melphalan 55 years ago was followed by a stagnant period of four decades in which many combinations of alkylating agents and chemotherapeutic drugs were developed without a significant increase in overall survival. The first novel agent, thalidomide, was introduced 15 years ago when it was used as an anti-angiogenesis agent. This was followed by a proteasome inhibitor, bortezomib. Then lenalidomide, a second-generation analog of thalidomide was introduced. More recently carfilzomib, a proteasome inhibitor, and pomalidomide, a third-generation derivative of thalidomide have entered the marketplace. Many new agents are in development and potentially available for future therapy.